So how does Alzheimer's progress? If you look at HELP SHEET 2, you will see I have given you a sheet I commonly refer to as a "break down" in a glance. It is neither indepth nor really informative, but I wanted you to become familiar with how changes occur. Once you've given it an overview we will continue on until you have a very comprehensive idea of how the disease advances.

If you will notice (in HELP SHEET 3), even in the advanced stage of 5 the changes are not dramatic. To friends and acquaintances, they are still socially active people. They still hold jobs, they still carry on conversations and for the most part, the "outside" world see views them as normal. However, underneath this social facade many devastating changes are taking place. Even in early stage 5, their reality is now based on misconception. They begin to wander and lose their train of thought.

By the middle of stage 5 they are now suffering delusions, anxiety attacks, and are becoming nocturnal in nature. Their reality is now becoming based on their own perception of what is right and wrong...what is real and what is not. By late 5 families begin to see the onset of paranoia and fear. And by now, the disease has already destroyed 50% of the brain.

By stage 6, most everyone will now be aware that something has changed. The person begins to look unkempt. They may develop a body odor from lack of personal hygiene, there is now noticeable gaps in communications, and work skills are sorely lacking. Their posture begins to slump, they may shuffle their feet, and their dexterity is poor.

The normal behaviors at this stage is varied. Repetitive gestures and thoughts begin, they may still drive but become lost in familiar surroundings. The anxiety level increases in stage 6. Their ability to recognize loved ones is decreasing. They are experiencing mood swings, delusions and an increase in suspiciousness. They can no longer think abstractly so misconceptions multiply. Their language becomes very difficult to understand and is replaced with nonsensical words or gibberish.

Now review HELP SHEET 4 to see how they are digressing!

In HELP SHEET 5, I have given you the Progressive Phases of Alzheimer's Disease. Again like the above help sheet 1, it does not give a large listing of symptoms. Instead, it is just a general overview of what you might see in a person with Alzheimer's.

Rather than breaking it down into stages, these sheets deal with the cognitive, personality and functional changes that can happen. While it lists the more prevalent symptoms, please remember that none of these are set in stone. Symptoms vary in each individual, and while all will probably suffer most of them (to some extent), depending on the area of the brain affected, and the extend of the disease, severity of symptoms/behaviors may differ.

(The Phases) In PHASE ONE, the onset is very gradual. The cognitive changes range from the inability to find the right words in a conversation, to forgetting familiar names and addresses. Their judgement is becoming impaired, they are using family members to fill in the memory gaps and their reactions or judgements may begin to appear irrational.

As for their personality, that is also changing. They may seem lackluster or less spontaneous. They may begin to appear self centered or self absorbed. There can be a sense of aloofness about them that is unexplainable and they may have a tendency to anger more easily.

As for their functional abilities, they are greatly impaired. Work skills fall off as they seek advice or opinions. Their overall persona is one of uncertainty and indecisiveness.

By PHASE TWO there is greater cognitive decline. Their decision making skills are impaired. Their family may begin to see a new personality emerging or at the very least, an altering of their behaviors. They can no longer retain new information and their recall is very limited. They may begin to digress back in time and relate stories and events that have happened years ago.

By now their personality has undergo a change. They are less social since they can no longer follow conversations. They may appear fearful or anxious in large groups of people. As they withdraw from reality they may appear self centered or unconcerned about those around them. There is no enthusiasm or interest in life.

The functional changes are so deteriorating. They must be guided through most of their daily routine. Things like bathing, dressing and eating must be supervised. Incontinence begins as does compulsions such as wandering or the onset of nocturnal behaviors. By now they are anxious, fearful, suspicious, and paranoid.

By PHASE THREE complete supervision is a way of life. There is little left of their abilities and they can no longer walk or talk. By the final phase, (the terminal stage) their ability to sit up, smile or hold their head up, is gone. They can no longer communicate. They will be mute and unresponsive to spoken words. They will no longer recognize familiar face, objects or places.

HELP SHEET 6 is probably the most comprehensive listing of behaviors and symptoms you will see concerning Alzheimer's disease. While it is unlikely every Alz. person will experience ALL of these digressions, most WILL display a good part of them. However, many of the last group of symptoms you will not see. By this stage the person is in the terminal stage confined to either home or nursing care facility.

*** Because communicating is such a difficult task, you will find through this booklet, a lot of general and specific ways to help you speak with Alzheimer's victims. ***

Now that you have a pretty good idea what happens to the person with Alz. lets move on to language problems. As you've noticed, communication skills are greatly affected and can result in any number of problems should the person become lost. So how does the language deteriorate? In help sheet 7 we explore the difficult tasks people have in trying to communicate with someone whose ability to converse is limited.

You see, when language skills begin to deteriorate it becomes a difficult, albeit sometimes impossible task to understand what they are trying to express. As you can see in HELP SHEET 7, even early on, (i.e. early forgetful stage) their verbalization skills can be hindered by problems associated with Alz.

(Early Forgetful Stage = approximately Stage 5)

Comprehension

One of the first things you notice under comprehension is the fact that noisy environments and rapid speech can be a real hinderance in helping an Alz. person perceive a situation. As you already know, by now, their brain is 50% destroyed by the disease so their awareness to circumstances is greatly impaired. Unfortantely, in this stage, the person is very astute at hiding any disadvantages the disease may be causing them, so don't be fooled into believing they have a clear 'grasp' as to what is going on.

Linguistic Skills

Their speech pattern may seem forced or disjointed and lacking in emotional spontaneity. There will be gaps in their conversations since they process what they want to say much more slowly. They may use non-specific words or select words similar in nature to those they can't remember.

Social Skills

They commonly will adlib or fall into a pattern of using clich,s to generalize conversations. They have a tendency to repeat themselves or ramble on. They may ask you to repeat the question then give you an answer that has nothing to do with what you asked. Again, you will probably see them struggle to respond to you.

(Middle Stages = approximately Stage 6)

Comprehension

By this stage, there is great difficulty with comprehension. Their attention span is now down to less than 5 minutes so most of your conversation will be forgotten very quickly. In this stage they may begin to repeat; "I want to go home", and they are easily distracted by any noise or movement. They will have great difficulty focusing on you or what you are saying. Eye contact is vital at this stage because you never know how much they are absorbing.

Linguistic Skills

As I just mentioned, in this stage, repetition becomes a problem. Anxiety is now causing other symptoms to surface and they may begin to repeat something over and over again. The more stressed/anxious they become, the more apt they are to reply with jumbled word or in sentences that make no sense.

Social Skills

As for their social skills; these are few and far between. There is an overall sense of withdrawal when the situation becomes to much for them. They may look at you with a vague, empty expression. They may pace restlessly while repeating a phrase over and over again.

So, how do you communicate with someone who is showing the above problems? As I said before, one of the most difficult tasks is relating and having yourself understood by a person with Alzheimer's. In HELP SHEET 8 I have given you what I call a "cheat sheet". It lists numerous suggestions on ways to improve communicating with a person who suffers from language / comprehension deficits.

In the next area, we will begin to explore some of the hints used in dealing with people who have Alzheimer's.